Nursing Care Plan (NCP) for Infective Conjunctivitis / Pink Eye
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Lesson Objective: Infective Conjunctivitis / Pink Eye Nursing Care Plan
- Understanding Infective Conjunctivitis:
- Gain knowledge of the pathophysiology, causes, and contributing factors of infective conjunctivitis, including bacterial, viral, or allergic origins.
- Recognition of Signs and Symptoms:
- Learn to recognize the characteristic signs and symptoms of infective conjunctivitis, such as redness, itching, discharge, and swelling, to facilitate early identification and intervention.
- Knowledge of Diagnostic Procedures:
- Understand the diagnostic procedures involved in confirming infective conjunctivitis, including clinical examination, microbial cultures, and laboratory tests, to guide appropriate nursing interventions.
- Implementation of Infection Control Measures:
- Acquire skills in implementing infection control measures to prevent the spread of infective conjunctivitis, including proper hand hygiene, isolation precautions, and education of patients and caregivers.
- Development of Individualized Care Plans:
- Learn to develop individualized nursing care plans based on the specific etiology (bacterial, viral, or allergic) and the unique needs of the patient, considering factors such as age, comorbidities, and patient preferences.
Pathophysiology of Infective Conjunctivitis / Pink Eye
- Bacterial Conjunctivitis:
- Caused by bacteria such as Staphylococcus aureus, Streptococcus pneumoniae, or Haemophilus influenzae.
- Infection often starts unilaterally but can become bilateral.
- Bacteria invade the conjunctival tissues, leading to inflammation and discharge.
- Viral Conjunctivitis:
- Common viruses include adenoviruses, herpes simplex virus, and enteroviruses.
- Highly contagious and often spreads through respiratory droplets or direct contact with infected eye secretions.
- Viruses invade and replicate in the conjunctival cells, causing inflammation and immune response.
- Allergic Conjunctivitis:
- Triggered by exposure to allergens such as pollen, dust mites, or pet dander.
- Immune response involves the release of histamines and other inflammatory mediators.
- Chronic exposure can lead to persistent inflammation and symptoms.
- Inflammatory Response:
- In all types, there is a common inflammatory response involving dilation of blood vessels (hyperemia), increased permeability, and infiltration of immune cells.
- Release of inflammatory mediators results in the characteristic redness, itching, and swelling.
- Discharge and Contagiousness:
- Bacterial conjunctivitis often presents with purulent discharge, while viral conjunctivitis may have watery discharge.
- Contagiousness varies but is high in bacterial and viral cases during the acute phase.
- Adequate treatment and infection control measures are essential to prevent transmission.
Etiology of Infective Conjunctivitis / Pink Eye
- Bacterial Etiology:
- Staphylococcus aureus: Common cause, especially in cases associated with poor hygiene.
- Streptococcus pneumoniae and Haemophilus influenzae: Other bacterial strains that can cause bacterial conjunctivitis.
- Transmission often occurs through direct contact with contaminated hands or objects.
- Viral Etiology:
- Adenoviruses: Most common viral cause of conjunctivitis.
- Herpes Simplex Virus (HSV): Can cause a severe form of viral conjunctivitis.
- Spread through respiratory droplets or contact with infected eye secretions.
- Allergic Etiology:
- Exposure to Allergens: Common allergens include pollen, dust mites, animal dander, and certain eye drops.
- Individuals with a history of allergies are more prone to developing allergic conjunctivitis.
- Seasonal variations may influence the prevalence of allergic conjunctivitis.
- Environmental Factors:
- Irritants: Exposure to smoke, pollution, or chemicals can irritate the eyes and contribute to conjunctivitis.
- Prolonged exposure to irritants may exacerbate symptoms and prolong the duration of conjunctivitis.
- Contact Lenses and Eye Products:
- Improper Lens Care: Poor hygiene or extended use of contact lenses without proper cleaning can lead to bacterial conjunctivitis.
- Contaminated Eye Products: Use of contaminated eye makeup or shared makeup applicators can introduce infectious agents.
Desired Outcome for Infective Conjunctivitis / Pink Eye
- Resolution of Symptoms:
- Achieve relief from symptoms such as redness, itching, and discharge.
- Gradual reduction of symptoms indicates effective management and healing.
- Elimination of Infective Agents:
- Eradication of bacterial or viral agents causing conjunctivitis.
- Negative cultures or tests for specific pathogens confirm successful treatment.
- Restoration of Normal Vision:
- Improvement in visual acuity and clarity.
- Minimization of visual disturbances, such as blurred vision, due to conjunctival inflammation.
- Prevention of Complications:
- Prevention or management of potential complications, such as corneal involvement or secondary infections.
- Timely intervention reduces the risk of long-term ocular sequelae.
- Patient Education and Preventive Measures:
- Enhanced patient understanding of preventive measures.
- Education on proper hand hygiene, avoidance of eye-rubbing, and strategies to prevent recurrent episodes.
Infective Conjunctivitis / Pink Eye Nursing Care Plan
Subjective Data:
- Itching of the eye(s)
- Pain in the eye(s)
- Sensitivity to light
Objective Data:
- Erythema of one or both eyes
- Swelling of the eyelid(s)
- Crusty appearance around the eye(s)
- Watery discharge from the eye
- Purulent drainage (yellow or green) from the eye
Nursing Assessment for Infective Conjunctivitis / Pink Eye
- Subjective Data:
- Obtain information on the onset of symptoms, including redness, itching, discharge, and any recent exposure to irritants or individuals with conjunctivitis.
- Ocular History:
- Gather details about the patient’s ocular history, including any previous episodes of conjunctivitis, allergies, or chronic eye conditions.
- Symptom Severity:
- Assess the severity of symptoms, including the degree of redness, presence of discharge (color, amount), and subjective discomfort.
- Visual Changes:
- Inquire about changes in visual acuity, blurriness, or sensitivity to light.
- Document any impact of symptoms on daily activities.
- Exposure and Risk Factors:
- Explore potential sources of exposure, such as recent respiratory infections, close contact with affected individuals, or environmental factors (allergens, irritants).
- Systemic Health:
- Evaluate the patient’s overall health, considering the presence of systemic conditions or immunocompromising factors that may affect the course of conjunctivitis.
- Physical Examination:
- Inspect the eyes for redness, swelling, discharge, and signs of inflammation.
- Assess visual acuity and any associated eye movements.
- Check for preauricular lymph node enlargement.
- Diagnostic Tests:
- Collaborate with the healthcare team to perform diagnostic tests, such as conjunctival swabs for culture or other specific tests to identify the causative agent.
Implementation for Infective Conjunctivitis / Pink Eye
- Topical Medications:
- Administer prescribed topical antibiotics or antiviral medications as directed.
- Instruct the patient on the proper technique for applying eye drops or ointments to ensure effectiveness.
- Warm Compresses:
- Encourage the use of warm compresses to alleviate discomfort and help reduce crusting or sticky discharge from the eyes.
- Educate the patient on the correct method for applying warm compresses and emphasize the importance of cleanliness.
- Hygiene Practices:
- Emphasize the significance of good hygiene, including frequent handwashing to prevent the spread of infection.
- Instruct the patient to avoid touching or rubbing the affected eye(s) to prevent further irritation or spread of the infection.
- Isolation Precautions:
- Advise the patient on necessary precautions to prevent transmission, especially in cases of bacterial or viral conjunctivitis.
- Provide guidance on the appropriate duration of isolation and when it is safe to return to regular activities.
- Symptomatic Relief:
- Recommend over-the-counter artificial tears or lubricating eye drops to relieve dryness and soothe the eyes.
- Discuss the importance of avoiding potential irritants, such as smoke or allergens, during the recovery period.
Nursing Interventions and Rationales
- Assess eyes and vision Assess for signs of ear infection
- Assess vitals
- Use proper PPE and disinfect all equipment per facility protocol
- Obtain history from patient and parents, depending on the patient’s age
- Apply a warm compress over eye
- Instill drops and apply ointments to eyes as necessary. Administer medications as required
- Encourage patient to remain home from school or daycare for approximately 7 days
- Educate patients and parents/caregivers of proper hygiene and how to prevent further spread of infection:
- Avoid rubbing the eye(s)
- Clean eye discharge with a tissue (dispose of carefully)
- Do not share towels or clothing with others
- Teach parent to instill eye drops or apply ointments at home for continued treatment
Evaluation for Infective Conjunctivitis / Pink Eye
- Resolution of Symptoms:
- Assess the patient for the resolution of clinical symptoms such as redness, itching, discharge, and swelling.
- Document the improvement or absence of symptoms as compared to the initial assessment.
- Effectiveness of Medications:
- Evaluate the effectiveness of prescribed medications by assessing whether the infection has responded to antibiotic or antiviral treatment.
- Monitor for any adverse reactions or side effects related to the medications.
- Patient Compliance:
- Verify patient adherence to the prescribed treatment plan, including the proper administration of medications and adherence to isolation precautions.
- Address any concerns or barriers to compliance expressed by the patient.
- Prevention of Spread:
- Assess whether preventive measures, such as hand hygiene and isolation precautions, have been followed to minimize the spread of infective conjunctivitis.
- Determine if there are any reported cases of the infection in close contacts.
- Educational Outcomes:
- Evaluate the patient’s understanding of hygiene practices and self-care measures to prevent future occurrences.
- Assess the patient’s ability to recognize and respond to early signs of recurrence or complications.
References
- https://www.healio.com/pediatrics/eye-care/news/online/%7B364d4d0f-901c-41dc-ad8b-ab2fac10edf0%7D/pediatric-acute-bacterial-conjunctivitis-an-update
- https://kidshealth.org/en/parents/conjunctivitis.html
- https://www.webmd.com/eye-health/ss/slideshow-pinkeye
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Example Nursing Diagnosis For Nursing Care Plan (NCP) for Infective Conjunctivitis / Pink Eye
- Impaired Comfort: Conjunctivitis can cause discomfort, itching, and redness. This diagnosis focuses on comfort measures and symptom relief.
- Risk for Infection Spread: Conjunctivitis is contagious. This diagnosis emphasizes infection prevention and education on hygiene and transmission.
- Knowledge Deficit: Patients with conjunctivitis may need education on proper eye care and the importance of medication compliance.
Transcript
Let’s create a care plan for infective conjunctivitis. Conjunctivitis, or what’s commonly referred to as pink eye, is an infection of the membrane that covers the eye in lies, the eyelid, or the conjunctivitis. In fact, pink eye is caused by a virus or bacteria. It normally occurs in one eye, although it can spread to both eyes. Pink eye is very contagious and it’s easily spread through poor hand hygiene, which is why it’s so common in children. Uh, some nursing considerations are, we want to assess the eyes and assess the vision. While vision loss is not common, it can occur. We want to educate patients on precautions and we want to educate the parents on how to stop the spread and to perform proper hand hygiene. The desired outcome is for the patient to be free from infection. The patient will have no change or loss of vision, and the patient will be free from pain and discomfort.
This is just a look at conjunctivitis. So typical symptoms for conjunctivitis include erythema, or redness, watery, or purulent drainage. And across the appearance. If you notice here in the picture, you see her eyes are very red. It’s kind of swollen around. Like I said, there may be some drainage, like I said, watery or purulent drainage. So what is the patient going to tell you, what is the subjective data that we can put here for infective conjunctivitis? Well, the patient is definitely going to complain of itchiness; it is going to be very itchy. Okay. There may be some pain in one or both of the eyes and they are going to be very sensitive to light. Some things that we’re going to notice off the bat from an assessment standpoint is we’re going to notice redness; that eye is going to be fire red.
There is also going to be some swelling in the eyelid. There’s going to be a crusty appearance around the eyes, especially when the patient first wakes up. There’s going to be some watery discharge from the eye or purely in drainage. What could be yellow or green in color from the eye. So we want to assess the eye. That’s our first nurse in the intervention. We want to assess the eye and assess for signs of eye infection. So the common side effects of pink eye include redness, clear drainage or purulent drainage, and visual loss. Like I said, it’s not typical, but it may be distorted or blurred. Otitis media or an ear infection is common. Coinfection and symptoms may often overlap. We want to make sure we use proper PPE and disinfect all equipment per a facility protocol. So bacterial and viral conjunctivitis are spread through contact.
So we want to make sure we use contact measures. So we want to make sure we use gloves. We want to make sure that we’re wiping everything down, disinfecting all equipment so we can prevent cross-contamination from other patients. We want to encourage the patient to remain home from school or daycare for about seven days. Pink eye infections are common and highly contagious and easily spread isolated. The patient from other children will prevent the continued spread of the illness. I remember when my niece was in school and there was an outbreak of pink eye, and literally it went from one kid to the next, to the next to where just about all of her class was down. Had they isolated the child at home? Did some good hand hygiene? I’m sure that that outbreak would have been minimized.
We want to educate. Education is key here. Education is key because it’s very important for this disease process to be managed at home. So the nursing intervention that we can do is we can educate the parents to apply warm compresses over the eye. We want to make sure that the compact, the calm press is moist and warm, not hot. It helped relieve some of the discomfort, drops may be ordered by the doctor and prescribed. We want to make sure that they’re instilling the drops and apply ointments to keep that eye comfortable. The medication, some of the medications that may be required would be some antibiotic drops or ointments. That’s going to treat that bacterial infection and to histamines decongestant steroids may also be used to release some symptoms. We want to make sure that the parent is on top of hand hygiene. We want to make sure that they don’t share towels or clothing with others.
We want to teach patients and teach parents how to put the eyedrops in and in order to avoid cross contamination. And we want to clean any discharge with tissue. That’s disposed of carefully. Here is the completed care plan. Next, we’re going to focus on some key points that you want to keep in mind. So the pathophysiology behind it, in fact, if pink eye is caused by a virus or bacteria in the conjunctiva, or the eye is infected some subjective or objective data that we may receive from the patient, subjective, itchy, very itchy, the eyes are itchy pain, and they’re sensitive to light. We, as nurses are going to observe or some objective data, we’re going to gather, uh, it’s going to be red. There may be some watery or purely from the eye, and that can be one or both eyes. We want to make sure that the parents are adhering to and the patients are adhering to hand hygiene. Okay? Scrupulous hand-washing is very important for at least 20 seconds. Avoid touching eyes. It’s the best way to stop the spread of pink eyes at home. No rubbing, don’t share towels again, hand hygiene, a warm winter compress for comfort and staying home from school until this disease is resolved.
We love you guys; go out and be your best self today as always happy nursing.
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